Data, Referral Partnerships Keys to Success in Value-Based Hospice Care

The rising tide of evolving payment models forthcoming in 2021 have hospice providers nationwide bracing for waves of change in end-of-life and serious illness care. As the move towards value-based care takes effect, providers will need to expand referral partnerships and enhance data analysis efforts to improve access to patients and families who could benefit from hospice or palliative care further upstream in their illnesses.

Hospice providers have increasingly looked ahead as the value-based payment arena opens up to include end-of-life care. Starting January 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) will roll out the Primary Care First initiative and add a hospice component to the value-based insurance design (VBID) program, both focused on improving the quality and continuity of patient care as their illnesses progress. The VBID demonstration project is commonly called the Medicare Advantage hospice carve-in.

Designed to increase coordination among care providers as patients transition across settings, hospices planning to participate in VBID payment models stand to gain greater access to a broader range of patients further upstream in the course of their illnesses. CMS expects this to result in improved patient and family experiences and outcomes. With public perception a common barrier to access, the ability to interact with patients sooner in a value-based payment environment is anticipated to shift hospice care under a new public scope.

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“Hospices traditionally have been a little behind the curve when it comes to that really consumer-driven model,” said Jennifer Sheets, CEO for Interim HealthCare Inc., in a Hospice News Virtual Summit on Value-Based Care. “We really need to shift our thinking to align with the fact that our patients are becoming consumers of health care, not just recipients. This really changes the way we interact, beginning with how we provide information about hospice care. There’s still such a knowledge deficit out there as to what hospice is and the tremendous support it is for the patient and the family. In a world of value-based Medicare Advantage, continuing to beat that drum of value plus quality should be heard and recognized.”

In addition to hospice and palliative care, the Interim HealthCare company has franchise locations that provide home health care, home pediatric care, health care staffing and senior care services in 41 states across the nation. The company recently expanded its hospice footprint further into the South with a new Louisiana franchise location.

“We are working with partners to explain how and where hospice can have the most impact on controlling cost,” said Sheets. “We’re building toolkits to help identify the right times to transition care, involving outreach to partners and help them really understand the benefits of palliative and hospice care and rupture the stereotypes to help other providers overcome their own barriers to using hospice.”

Value-based care collaborations among providers could also have rippling effects on the way hospices do business as a widening pool of referral resources opens up. Currently relying heavily upon referrals from such settings as hospitals, skilled nursing homes or long-term care facilities, hospices will have expanded reach into a variety of different health care settings under the value-based models of continuous care. Insurance payer input and patient choice will be key drivers of hospice referral sources.

According to Rafael Sciullo, president and CEO of Florida-based Empath Health, hospice providers should focus on building relationships with Medicare Advantage insurance payers as a crucial step towards growing their referral base in a value-based payment environment.

“The payer will be the plan and will also be somewhat of a referral source,” said Sciullo, who also spoke at the value-based care summit. “Relationships with the plans and with the payers will be absolutely pivotal. There will be a real priority on service diversification as a strong focus beyond the hospice service, that you’re touching people at different points in their life and really focusing on their needs.”

Gearing toward value-based models may also impact the way hospices track and measure care delivered, with communicating quality data performance a factor in driving payer and public interest.

“We’re really digging into the data that value-based organizations are wanting,” Sheets said. “That’s really going to be key not only to make sure we are appropriately monitoring key performance indicators, but it’s also going to be key in negotiating with payers. Start having conversations with partners in our market to understand specific roadblocks. and where hospice can help.”

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